NANA SEBASTIAN. .pptx

Mental health

1. MENTAL HEALTH BULIMIA NERVOSA GROUP 6A

2. OBJECTIVES At the end of this presentation, students should be able To define Bulimia Nervosa To understand the epidemiology of bulimia nervosa To describe the symptoms, causes and management of bulimia nervosa To understand diagnosis criteria and investigation To understand treatment of bulimia nervosa

3. BULIMIA NERVOSA Bulimia nervosa is a life threatening eating disorder marked by binge-eating and severe weight control. This condition causes distress and disability, leading to compensatory behaviors like self-induced vomiting and diuretic and laxative abuse , non-purging habits such as strenuous exercise, strict diets, and extended fasting. Bulimia nervosa can develop after experiencing physical, emotional, mental, sexual, or verbal abuse. BN patients often have a normal weight, however some may be underweight or overweight

4. Cont.. . Bulimia nervosa typically affects normal physiological functioning, Electrolyte and metabolic abnormalities are the leading causes of illness and mortality among people with bulimia nervosa.

5. Types of bulimia nervosa Purging type A person regularly engage in self induced vomiting or the misuse of laxatives, diuretics or enemas. Most common cases Non –purging type A person use the inappropriate compensatory behavior e.g fasting, excessive exercising to control weight but has not regularly engaged in self induced vomiting, misuse of laxatives or enemas.

6. Behavioral and emotional symptoms Frequent visit to the bathroom particularly after meals. Excessive exercising Preoccupation with body image Intense fear of gaining weight Depression, anxiety or substance abuse Feeling out of control Feeling guilty or shameful about eating Withdrawing socially from friends and family

7. Physical symptoms Swollen cheeks or jawline Gastrointestinal problems such as constipation and acid reflux Scar, scrapes or calluses on the knuckles Fainting Irregular menstrual periods Muscles weakness Bloodshot eyes dehydration

8. EPIDEMIOLOGY - The prevalence of BN in the United States is believed to be between 1-3% of the overall population. The average age of onset is between 16 and 18 years old. Females are affected in greater numbers than males, with a female to male ratio of 10 to 1. - According to a study (Ho et al, 2006), the prevalence of eating disorders in Singapore is approximately 7.4%. . The prevalence rate of bulimia nervosa in women in Africa is within the range recorded for western groups, including African Americans and Latin Americans.

9. Cont.. . The few studies undertaken suggest that the prevalence of bulimia nervosa (BN) is lower in Africa than globally, In Tanzania, the research by Eddy e t. all (2007) focused in young Tanzanians female and found that 1 woman (0.5%) met the criteria for bulimia nervosa, this indicates as a relative low prevalence f bulimia nervosa in this population compared to the eating disorders like anorexia nervosa .

10. CAUSES OF BULIMIA NERVOSA Genetic factors Evidence suggest that genetics play a role in predisposing individual to eating disorders such as bulimia nervosa, research has show that individuals with family history of eating disorders are at high risk f developing bulimia . Psychological factors Low self esteem , body dissatisfaction and distorted body image, stressful life event, trauma, difficulties in coping with emotions are common characteristics.

11. Cont Environmental factors Societal pressure to attain unrealistic standards of beaut and thinness portrayed in the media can impact body image and self esteem, culture attitude towards weight and appearance also influence an individual relationship with food and body image Peer influence Individual with close friends or family members who engage in disordered eating behavior may be more susceptible to adopt.

12. Cont.. Co-occurring mental health disorders Other mental disorders such as depression, anxiety, substance abuse or personality disorders can contribute to bulimia development

13. DSM 5 CRITERIA FOR DISORDER

14. DIAGNOSTIC TEST Physical examination findings involves measuring weight and height ,checking vital signs ,skin ,nails, heart and lungs and examining the abdomen. Psychological evaluation Mental health provider asses though ,feelings, and eating habits trough interviews and questioners .

15. Conti… Laboratory test Complete blood count, Electrolyte test liver ,kidney, and thyroid function urinalysis

16. LABORATORY INVESTIGATIONS Core laboratory findings • FBC: leukopenia and lymphocytosis. • U&Es: ↓ in K+, Na+, Cl-, ↑bicarbonate ↑ in serum amylase • Metabolic acidosis due to laxative use • Metabolic alkalosis due to repeated vomiting .

17. MANAGEMENT 1. PSYCHOTHERAPY ; COGNITIVE BEHAVIORAL THERAPY This is the most commonly used psychotherapy approach for treating bulimia nervosa. It focuses in changing the distorted thoughts and behaviors related to food, body image and self esteem. 2. NUTRITION COUNSELING Nutrition counseling involves establishing healthy eating patterns, break the cycle of binge eating and purging and develop a balanced approach to food and nutrition and also it help him or her to learn to listen to their body’s hunger and fullness cues and make informed choices about food.

18. Cont … 3. REGULAR MEDICAL CHECK UP This help to monitor physical health and address any complications related to bulimia nervosa such as electrolyte imbalances, dehydration or gastrointestinal problems. In severe cases hospitalization will be necessary to stabilize the individual’s health 4. SUPPORTIVE GROUPS Engaging in group therapy can help individual with the peer support and encouragement by sharing experience with others who understand the challenges of living with bulimia .

19. Cont … 5. MEDICATION Selective serotonin reuptake inhibitors which are type of antidepressant are used to reduce the frequency of binge eating and vomiting. They are effective in treating also anxiety and depression.

20. Nursing management Engage patient in therapeutic alliance to obtain commitment to treatment. Monitor the weight Correction of the nutritional deficiency by providing the nutritious diet Establish the contact with the patient that specify the amount and type of food he/she must eat Teach the patient to keep journal to monitor high risk situations that brings purging behavior

21. Cont.. Control vomiting by making bathroom inaccessible for at least 2hr after food Monitor serum electrolysis level Encourage the patient to recognize and verbalize her feeling about her eating disorder Explain the risks of laxative, emetics and diuretics abuse.

22. REFERENCES DSM 5 2013 K.P Neerja Essential of mental Health and psychiatry Nursing second editions. Jaypee brother publishers. Page 380-390 Lippincot William and Wilkins, A textbook of the psychiatry mental health nursing fifth editions, Wolter Klower publication, page 380-394

23. PARTICIPANTS Happiness A riya Annastazia Sebastian Josephine magoma